MNJ (Malang Neurology Journal)

PHOTOBIOMODULATION ON MUSCLE STRENGTH AND FATIGUE IN MULTIPLE SCLEROSIS: SYSTEMATIC REVIEW

2023-09-18T17:04:27+00:00

Background: Photobiomodulation plays an important role in modulating the inflammatory process, accelerating tissue repair, which can be beneficial in cases such as multiple sclerosis.

Objective: To carry out a literature review about effectiveness of photobiomodulation on muscle strength and fatigue in multiple sclerosis.

Methods: The databases included were PubMed, Embase, Cochrane, Web of Science, Scopus and LILACS (Latin American and Caribbean Health Sciences Literature). Also the gray literature: Google Scholar, LIVIVO (ZB MED Search Portal for Life Sciences), Open Grey and Library of Thesis and Dissertations CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). The risk of bias was assessed using the Cochrane tool, Rob 2, and the data was extracted and assessed by blinded reviewers.

Results: Initially 7302 records were found, 7102 in the main databases and 200 in the gray literature. After removing duplicates, 4217 studies were left for Phase 1 and 10 for Phase 2. Finally, 3 randomized clinical trials were included in this review.

Conclusion: The studies included risk of bias in this review was predominantly low. PBM proved to be effective in improving muscle strength, but not fatigue. However, the number of human clinical trials is still too few for a more conclusive analysis.

THE SAFETY AND OUTCOME OF ACUTE ISCHAEMIC STROKE PATIENTS WITH COVID-19 TREATED WITH INTRAVENOUS RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR: A SYSTEMATIC REVIEW

2023-10-23T04:16:34+00:00

Background: Strokes associated with SARS-CoV-2 may be linked to increased mortality rates. The utilization of intravenous thrombolysis is anticipated to enhance the clinical results in such patients. Moreover, emerging evidence underscores the importance of evaluating the safety and effectiveness of intravenous thrombolysis in individuals suffering from Acute Ischaemic Stroke along with COVID-19.

Objective: To assess the safety and effectiveness of intravenous thrombolysis in Acute Ischaemic Stroke patients with COVID-19.

Methods: A systematic literature search (Pubmed, Elsevier, and Cochrane database) with keywords (((intravenous thrombolysis) AND (acute ischemic stroke)) AND (covid-19)) AND (outcome))). We selected research studies for evaluation based on specific inclusion and eligibility criteria. Two independent reviewers then proceeded to extract and analyze various data points, including the name of the first author, the year of publication, the study's design, the National Institute of Health Stroke Scale (NIHSS) scores at admission and post-treatment, hospitalization-related mortality, and the occurrence of hemorrhagic transformation.

Results: Three studies (n=153 patients) were included, mostly men with advanced age with the most common comorbidity being hypertension. Median of NIHSS Score of subjects on admission is 11, 12, and 13, with interquartile range from 3 to 20 (minor to severe stroke). The mRS at discharge and 1 month after admission is: 0–2 pts in 57 patients, ≥2 in 43 patient. Hemorrhagic transformation involved 3.23% of patients from total samples, death within hospitalization and 1-month mortality were in 23 patients (15%). In numerous studies, there was inadequate data available to determine the precise reason for mortality.

Conclusion: Following IV-rTPA therapy, our COVID-19 infection subjects' mRS scores ranged from mild to moderate disability. Fifteen percents of all subjects died, and 3.23% of subjects experienced hemorrhagic transformation. However, majority of our subjects have high median NIHSS scores at admission, advanced age, complicated with baseline risk factors as high blood pressure, diabetes, and hyperlipidemia.

AUTOIMMUNE ENCEPHALITIS: DIAGNOSTIC AND TREATMENT APPROACH

2023-09-07T02:35:51+00:00

Autoimmune encephalitis is a type of brain inflammation induced by an inappropriate immune response to a neuronal antigen, resulting in the generation of autoantibodies. Autoimmunity as important cause of encephalitis in recent years has not been much reported in Indonesia. Increased familiarity with autoimmune encephalitis among physician, not only neurologist, is extremely important for early detection. Prompt diagnosis and early immunotherapy leads to better prognosis in this potentially treatable disease, despite a long disease course. Autoimmune encephalitis is characterized by acute-subacute progressive neuropsychiatric symptoms with associated cognitive dysfunction, encephalopathy, psychiatric disorders, movement disorders and seizures, with anti-N-methyl-D-aspartate (NMDA) receptors encephalitis as the most common type. In addition to clinical features, further diagnostic investigations needed are brain magnetic resonance imaging (MRI), electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, and autoantibody testing. Challenges in establishing diagnosis include wide range of clinical symptoms, absence of abnormalities in brain MRI, unspecified EEG findings, negative antibody testing, and limited availability of antibody testing in Indonesia. This literature review discusses the recognition, diagnosis and principle of treatment of autoimmune encephalitis.

A POLYMYOSITIS AFTER mRNA COVID-19 VACCINATION CASE REPORT

2023-02-27T04:58:43+00:00

Polymyositis is a rare, acquired, and inflammatory muscular disease, which is characterized by the inflammation of muscles and has no known etiology. The autoimmunity created by the vaccine arose from molecular mimicking or directly by vaccine adjuvants. Polymyositis cases were reported after hepatitis B, influenza A (H1N1), tetanus toxoid, and Bacille Calmette-Guerin (BCG) vaccinations. However, no relationship with COVID-19 vaccination has been reported yet. Myositis and dermatomyositis cases have been seen after covid-19 vaccine. m-RNA COVID-19 vaccines might cause abnormal activation of the immune system due to a strong t-cell-mediated immune activation by vaccinesin the present case, without any additional triggering factor, a case diagnosed with polymyositis developing 10 days after the second dose of messenger RNA (mRNA) COVID-19 vaccine is presented. The findings suggest a potential association between mRNA COVID-19 vaccination and the development of polymyositis, prompting further investigation into this rare occurrence.

PSEUDOBULBAR AFFECT AND COGNITIVE DECLINE POST SEVERE TRAUMATIC BRAIN INJURY: A CASE REPORT

2024-01-03T04:18:49+00:00

Introduction: Pseudobulbar affect is described as episodes of laughing or crying that occur suddenly and uncontrollably without appropriate stimulation. Pseudobulbar affect is often preceded by various neurological disorders, one of which is a history of severe head injury.

Case Report: Female, 21 years old, experienced sudden frequent laughing for no apparent reason and could not be controlled. This has been happening after she suffered a severe head injury, which was a subarachnoid hemorrhage, about two years ago. She was diagnosed with pseudobulbar affect according to Cummings criteria and confirmed by Center for Neurologic Study – Lability Scale (CNS-LS) questionnaire with a score of 19. The patient also complained of forgetting things, therefore a cognitive function was examined with Indonesian Version of the Montreal Cognitive Assessment (MoCA-Ina) with a score of 14 which indicated moderate cognitive impairment.

Discussion: Pseudobulbar affect post traumatic brain injury is suspected to be caused by decreased inhibition of sensory cortex transmission to the motor cortex and limbic system leading to disturbances in the cerebellum and decreased threshold for emotional expression. Pseudobulbar affect may coexist with impaired cognitive function due to the intersection of the anatomical structure of cognitive function with pathways that regulate emotion.

Conclusion: Pseudobulbar affect with cognitive impairment creates a burden and interferes the patient’s quality of life. It is necessary for health workers to be able to identify the clinical manifestations of pseudobulbar affect as a complication after traumatic brain injury, therefore optimal management for the patients can be achieved.

VASCULAR PARKINSONISM WITH EARLY COGNITIVE IMPAIRMENT: A CASE REPORT AND LITERATURE REVIEW

2024-01-03T04:25:31+00:00

Introduction: Vascular parkinsonism has a prevalence 4.4% to 12% of parkinsonism. Until now there are no specific diagnostic criteria to establish diagnosis of vascular parkinsonism, so it is often misdiagnosed with idiopathic parkinsonism.

Case Report: Male, 82 years old, with gait disorder 3 years ago, appeared stiff with small steps. The patient appears to be slower, drooling frequently, and has difficulty swallowing food. The patient was diagnosed with Parkinson's disease and given levodopa/benserazide. However, the progress of the disease was getting worse, so the dose was increased. Since 2 years, patient became forgetful and more irritable. History of ischemic stroke 3 years ago with no sequelae. History of hypertension and gout arthritis (GA). Patient was compos mentis without signs of focal deficit or lateralization, however, there was a cogwheel-type rigidity in all extremities without any tremor. MoCA-Ina (Montreal Cognitive Assesment Indonesian Version) test was 21. The head CT (Computer Tomography) scan revealed chronic lacunar infarct with brain atrophy and small vessel ischemic changes. Then patient was diagnosed with vascular parkinsonism and treated with levodopa, acetosal, candesartan and consulted to medical rehabilitation department.

Discussion: Based on criteria of Zijlmans et al., and Winikates and Jankovic, patient is included in vascular parkinsonism, namely the presence of bradykinesia, rigidity and postural instability which indicates a parkinsonism accompanied by 3 vascular scores.

Conclusion: Diagnosis of vascular parkinsonism is very complex and challenging. Multidisciplinary management from neurologists and medical rehabilitation specialists must be applied to improve the quality of life, reduce morbidity and mortality.

CEREBRAL VENOUS SINUS THROMBOSIS WITH GOOD RESPONSE TO HEPARINIZATION THERAPY: TWO CASE REPORT AND DIAGNOSTIC ALGORITHM

2023-10-13T04:03:00+00:00

Cerebral venous sinus thrombosis (CVST) is an uncommon condition of cerebral venous sinus thrombosis with a varied clinical presentation that can be diagnostically challenging. Intravenous heparin is the optimal immediate anticoagulant according to the European Academy of Neurology (EAN) guideline 2017. This report aims to describe highly suspicious CVST clinical features and suggest a diagnostic algorithm based on two cases of CVST found in our center. The first case is a 52-year-old man who presented with serial seizures preceded by subacute headache and diparesis. Non-contrast head CT (NCCT) showed multifocal haemorrhages and cord signs. The second case is a 19-year-old woman who presented with slowly decreased consciousness, headache, and a history of upper respiratory infection. Diffuse cerebral edema was revealed in NCCT. Both of these patients had thrombosis in superior sagittal sinus, right transverse, and sigmoid sinus. Heparinization was conducted and continued with rivaroxaban with a good response. CVST is rare case and often unrecognized; since it has serious complications, early diagnosis and treatment improve prognosis and survival.

COGNITIVE FUNCTION ASPECTS IN HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS: A CASE REPORT

2023-09-18T13:00:18+00:00

HIV-associated cerebral toxoplasmosis may lead to cognitive function impairment through accumulation of β-amyloid plaques and Tau protein which cause damage, inflammatory and oxidative processes in the brain. A 40-year-old, Balinese, right-handed female patient, came with chief complaint of three times of seizure before admission. After the seizures stopped, the patient was fully conscious again. Since the last 2 months, the patient seemed more confused and spoke a little slower. The patient also often repeated a story about something and forgot that she had already told it. The patient has a known history of HIV infection in the past 3 months before admission, she had taken anti-retroviral agents but she stopped them by herself since last 1 month. Anti-Toxoplasma IgG antibody showed reactive results and CD-4 of 62 cells/µL. The results of the overall cognitive function examination found mild cognitive impairment with activities that required mild assistance. HIV-associated neurocognitive disorders (HAND) are still a challenge to study, and the importance of improving patient cognitive function to maintain or increase aspects of independence and quality of life is a target in the care of HIV patients, especially patients with HIV-associated cerebral toxoplasmosis infection.

MYASTHENIA GRAVIS WITH FEATURES OF ACUTE PONS INFARCTION: A RARE CASE REPORT

2023-09-26T06:01:48+00:00

Background: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease at neuromuscular synaptic transmission. The clinical sign of a myasthenia gravis is the presence of weakness that affects vision (ocular), bulbar and proximal skeletal muscles and also myasthenia gravis can resemble vascular disorders or any infectious diseases.

Case: A 48-year-old Balinese male patient came to the emergency department of Prof I.G.N.G Ngoerah Central General Hospital complaining of shortness of breath. Shortness of breath is said to have occurred since one month ago. Shortness of breath improves slightly when the patient rests. Another complaint felt by the patient is that the right eyelid drops, especially during the daytime, will improve in the afternoon. The patient denied any weight loss or a history of malignancy. The patient about three months ago had fallen from a motorcycle and felt numbness in his right cheek until now. The patient has been undergoing treatment at the District General Hospital and he was diagnosed with myasthenia gravis and took Mestinon. CT scan of the head showed an acute infarction of the left pons accompanied by a suspicion of acute meningoencephalitis.

Discussion: From the results of the RNS (Repetitive nerve stimulation) in this patient, it was found that the neuromuscular junction lesion was supportive of the description of the myasthenia gravis case.

Conclusion: Myasthenia gravis is a disease of the nervous system with various manifestations. Good clinical examination and supporting examination are very necessary to confirm the diagnosis.

THE OUTCOME OF COGNITIVE THERAPY IN PATIENTS WITH FIRST-EVER STROKE AND RECURRENT STROKE

2024-02-22T14:22:37+00:00

Background: Vascular dementia (VaD) is the second most prevalent type of dementia that impacts elderly adults, succeeding Alzheimer's disease. In contrast to Alzheimer's disease, Vascular Dementia (VaD) presents a wide range of cognitive changes, which are greatly influenced by the specific neural regions that are impacted by vascular pathology. The incidence of dementia in adults with a prior history of stroke is 30%, demonstrating a frequency that is 3-5 times more than those without any discernible stroke-related impairments. In addition, the intensity or frequency of strokes may contribute to a decrease in cognitive reserve in persons with vascular dementia.

Case Report: We presented two cases of VaD. The first case was a 62-year-old man with a history of ischemic stroke without sequelae a year before the complaints of frequent forgetfulness and cognitive impairment. Neuropsychological examination showed neurocognitive disturbances in orientation, attention, memory, and visuospatial domain with impaired daily activities function. The MRI result showed senile brain atrophy with chronic infarction on the right temporoparietooccipital lobe, left side mesencephalon, right side pons accompanied by cortical laminar necrosis on the right frontal lobe and left temporoparietal lobe. The second case was a 79-year-old man with history of recurrent ischemic stroke (three times since 2021-2022) with sequelae of left hemiparesis and complaints of frequent forgetfulness and cognitive impairment in the last 1 year. Neuropsychological examination showed neurocognitive disturbances in orientation, attention, and visuospatial domain with impaired daily activities function. The MRI result showed subacute multiple lacunar infarctions in right insular cortex, right frontotemporal lobe cortex, right corona radiata, with multiple chronic infarcts on the right frontotemporoparietal lobe, right corona radiata, right internal genu capsule, right lateral periventricular anterior horn, pons, right left cerebellum, also senile brain atrophy. Both patients were diagnosed as VaD and given donepezil 1x10mg and memantine 1x5mg to treat the cognitive impairment. Both cases showed improvements after 6 months of therapy with MMSE from 17 to 28, MoCA-INA from 12 to 22 and MMSE from 19 to 23, MoCA-INA from 14 to 21 respectively.

Discussion: The probability of acquiring vascular dementia (VaD) was strongly associated with the incidence and frequency of strokes. The prevalence of newly developed dementia after the initial stroke is approximately 10%, which increases to 30% with recurrent strokes. The likelihood of experiencing cognitive impairment and dementia after a stroke is primarily determined by the specific attributes of the stroke. While pharmacological therapy largely focuses on cognitive impairment, other factors, such as the stroke's characteristics, might contribute to neuronal and molecular abnormalities that result in cognitive loss. Two instances were shown, both demonstrating enhancements, with the initial instance, involving primary strokes, exhibiting a superior outcome compared to the subsequent instance with recurring strokes. A more profound or recurring stroke has the potential to reduce cognitive reserve, hence potentially heightening vulnerability to neurodegenerative disorders, either directly or by means of modifications in social contacts or lifestyle, which can subsequently affect cognitive performance.

Conclusion: Recurrent stroke plays a role in reducing cognitive reserve and increasing the risk of dementia. Patients with VaD have shorter life expectancy, thus the severity of VaD is best managed by providing optimum acute stroke care and recurrent stroke prevention.

CASE SERIES: EFFICACY OF THROMBOLYSIS USING INTRAVENOUS ALTEPLASE IN ACUTE ISCHEMIC STROKE WITH ONSET LESS THAN 6 HOURS (CODE STROKE)

2023-12-01T02:22:26+00:00

Background: The gold standard therapy for acute ischemic stroke is timely reperfusion of ischemic brain tissue. Intravenous thrombolysis with tPA is the only proven medical therapy for acute ischemic stroke within 4.5 hours of symptom onset using intravenous alteplase at a dose of 0.9 mg per kilogram of body weight. Hemorrhagic transformation is one of the complications of thrombolytic therapy and East Asian population having a higher prevalence of cerebral hemorrhage. This study will examine several cases of ischemic stroke that were treated with thrombolysis using a standard dose (0.9 mg/kg) of intravenous alteplase in acute ischemic stroke with an onset of less than 6 hours in the Special Region of Yogyakarta, especially at the UGM Academic Hospital.

Objective: To determine the efficacy of standard dose thrombolysis using intravenous alteplase (rTPA-recombinant tissue plasminogen activator) in acute ischemic stroke with an onset of less than 6 hours through activation of the Code Stroke.

Methods: Descriptive research design using a case series, the hyperacute stroke patients with an onset of less than 6 hours who received intravenous alteplase which were then assessed by the National Institutes of Health Stroke Scale (NIHSS) score at initial admission, 24 hours post-alteplase and 30 days post -alteplase. The study took place and was conducted from May to October 2022 by administering intravenous alteplase at a dose of 0.9 mg/kg body weight in acute ischemic stroke patients at UGM RSA who are eligible for thrombolysis therapy with a maximum administration time of 6 hours after stroke onset with the maximum dose of alteplase is 50 mg.

Results: The study sample was 8 patients with acute ischemic stroke who were treated between May to October 2022. There were 2 patients who died before completing the 3-month follow-up. One of the patients died within the second week of treatment from sepsis which may have occurred from a pre-existing pneumonia. Another patient died from ileus that occurred 1 month after tissue plasminogen activator (tPA). However, the patient with this ileus showed clinical improvement at the 24-hour post-tPA follow-up, i.e. the initial NIHSS score of 12 improved to an NIHSS score of 6.

Conclusion: The modified Alteplase dose, which is 0.9 mg/kg body weight with a maximum dose of 50 mg, at the onset of stroke less than 6 hours can be an option to maximize thrombolytic therapy while still considering the efficiency of treatment costs.

SPINAL INTRADURAL EXTRAMEDULLARY TUMORS AND SIMILAR PATHOLOGIES: A SINGLE CENTER STUDY

2023-01-09T02:53:38+00:00

Background: We wanted to analyze the neurological symptoms and prognosis of five spinal IDEM (intradural extramedullary) tumors cases diagnosed, and to emphasize that a spinal cord tumor can be found incidentally in evoluation of the proximal regions of the vertebral column in patients who were mistakenly operated for lumbar disc herniation on lumbar MRI, but whosesymptoms did not resolve.

Objective: To emphasize the need for examinations such as MRI along the vertebral columna in patients with different spinal pathologies and whose symptoms and clinical signs do not improve.

Methods: Patients with spinal IDEM tumors treated with surgical excision and followed for more than 2 years were retrospectively analyzed. Issessed pain with the visual analo scale (VAS), and neurological function with the Nurrick grade.Preoperative complaint time,location of tumor in sagital and axial sections in MRI and pathological diagnosis were investigated.

Results: The pathological diagnosis in our study was meningioma in two cases,dural arteriovenous fistula in one case,teratoma in one case ,and myxopapilary epandimoma in one case.İn one case,disc herniation surgery was performed in another hospital due to misdiagnosis, but because the patient’s complaints were resistant. In examination, an IDEM tumor at T11 level was detected, and he was operated. In all cases the VAS score (mean) was reduced from 7.8 to 0.4 as well as the Nurrick grade (mean) was from 2.0 to 0.6. In the dAVF case, spasticity in the lower extremities, bladder and bowel disfunction continued.

Conclusion: In cases with severe neurological deficits, MRI scanning of the proximal parts of the vertebral column will help in the differential diagnosis of the lesion occupying the intraspinal space.

EVALUATION OF DEPRESSION FREQUENCY AND ITS EFFECT ON PROGNOSIS IN PATIENTS TREATED FOR ACUTE ISCHEMIC STROKE

2023-08-22T03:32:45+00:00

Background: Stroke is one of the most important causes of mortality and morbidity in the world. Although mortality and morbidity rates decrease with mechanical thrombectomy and intravenous thrombolytic treatments in suitable patients, post-stroke depression may develop in these patients. Poststroke depression occurs in approximately 30% of patients with stroke and is associated with poor prognosis and quality of life.

Objective: Depression is a common complication that leads to dysfunction even years after a stroke. In this study, we aimed to evaluate the frequency of depression, determine the risk factors, the relationship between the infarct localization and stroke severity in patients who underwent acute ischemic stroke treatment (intravenous tissue plasminogen activator (IV-tPA) and/or endovascular mechanical thrombectomy (MT)).

Methods: In this prospective study, 230 patients older than 18 years of age who were hospitalized with the diagnosis of acute ischemic stroke between 2021-2022 and treated for acute ischemic stroke were evaluated. Patient characteristics such as age, gender, education level, stroke risk factors, infarct localization were noted in the first month follow up outpatient clinic as well as their Modified Rankin Score (MRS), National Health Institutes Stroke Scale (NIHSS) and Beck Depression Scale (BDI).

Results: There was a statistically significant difference in age groups compared to BDI values (x2=10.215, p=0.037). A statistically significant difference was found between BDI levels and MRS (x2=21.177, p<0.001) and BDI score and NIHSS (x2=28.074, p<0.001). There was a statistically significant difference between education levels and MRS values (x2=17.147, p=0.002) and NIHSS scores(x2=14.715, p=0.005).

Conclusion: Whereas disability can lead to depression, depression is one of the leading causes of disability. Despite the benefit of acute stroke treatments, they are ineffective in preventing post-stroke depression and subsequent disability. Therefore identification, and prevention of risk factors and early treatment of depression are necessary to effectively prevent morbidity.

EVALUATION OF VITAMIN B12 LEVELS WITH NEUROPATHIC PAIN IN HEMODIALYSIS PATIENTS: A SINGLE CENTER OBSERVATIONAL STUDY

2023-09-20T07:28:55+00:00

Background: Uremic syndrome in chronic kidney disease (CKD), particularly in hemodialysis (HD) patients, is a growing global health problem. The majority of patients with this condition experience one or more neurological disorders, such as neuropathic pain. One of the adjuvant therapies in the treatment of neuropathic pain is vitamin B12, which is important for the regeneration and myelination of peripheral nerves and also plays an important role in the restoration of functional nerves.

Objective: The aim of this research is to evaluate the role of vitamin B12 in the relief of pain symptoms

Method: This research was conducted at General Hospital in Bali use a case-control design and consecutive sampling. This was carried use 21 patients with CKD on regular hemodialysis with neuropathic pain, while 22 patients without neuropathic pain were used as the control group. All patients were tested for serum vitamin B12 levels. Neuropathic pain was assessed using the DN4.

Results: The data values of total vitamin B12 levels in blood serum were obtained within a range of 81.72 pmol/L to 2337.5 pmol/L, and a median value of 1306.25 pmol/L. A cut-off value of 1509.375 pmol/L was obtained with 76.2% sensitivity and 59.1% specificity. Furthermore, an odd ratio between low serum vitamin B12 and the incidence of neuropathic pain was also obtained, namely OR= 3.611 (95% CI= 1.012-12.9; p=0.044).

Conclusion: It was found that low serum vitamin B12 in CKD patients on hemodialysis increased the risk of experiencing neuropathic pain by 3.611 times compared to those with normal serum vitamin B12.

THE EFFECT OF DRY NEEDLING THERAPY ON MYOFASCIAL PAIN SYNDROME

2023-09-18T03:33:15+00:00

Background: One of the nonpharmacological management that can currently be used to treat Myofascial Pain Syndrome (MPS) is dry needling (DN). Dry needling is a pain intervention technique by inserting a solid needle into the skin to stimulate myofascial trigger points (TrPs). In a previous study conducted at Central Hospital in Bali, DN was shown to reduce pain and oral analgetic usage in patients with upper trapezius muscle MTrPs, but the effect of DN on overall life quality (such as sleep quality and depression) is still lacking.

Objective: This research was conducted to find out whether there was an improvement in pain scale, depression and quality of sleep of health employees in Sanglah Hospital who experienced myofascial pain syndrome after dry needling therapy.

Methods: an observational experimental design, which compares the difference of the Numerical Pain rating score, Pittsburg Sleep Quality Index, and Hamilton Depression Scale before and after DN. The study used a consecutive sampling method to reach the designated sample size.

Results: A total of 53 samples followed the entire series of studies. The mean difference between NPRS before DN and after DN showed a significant result of p= 0.00 (<0.05), but in the aspect of PSQI and HDS no statistical difference.

Conclusion: There is a trend of improvement in the quality of life after DN from pain scale, mood condition and sleep quality. However, this research still cannot show a link between DN therapy with depressive disorders and sleep quality.

EFFECT OF BALINESE FLUTE INSTRUMENT FOR IMPROVING COGNITIVE FUNCTION IN ELDERLY

2023-09-18T04:22:16+00:00

Background: Cognitive impairment is mostly affected the elderly population which reduces the quality of life for sufferers and their families. The last research showed that listening to Balinese flute instrument music increased cognitive function, especially in the memory domain. However, the study is still limited to small populations.

Objective: to determine whether playing the Balinese flute with or without listening to the "Morning Happiness" song affects the cognitive function of elderly.

Methods: This experimental study was conducted on healthy geriatric patients above 55 years old with controlled risk factors or no history of any chronic conditions which were divided into 2 groups. The "Morning Happiness" song will be played with Balinese flute instrument in both groups whereas the intervention will add to listen to similar songs.

Results: 28 subjects in the intervention group and 20 subjects in the control group. Both groups were comprised of typical gender distribution with an average of 65.08±6.41 years old. Both the intervention and control groups had improved in MoCA-Ina (The Indonesian Version of Montreal Cognitive Assessment) scores, but the intervention group gained a better Z-score (-3.193, p-value 0.001) than the control group (-1.466, p-value 0.143) after procedural. The delayed recall domain also showed significant improvement in both groups with a Z-score of -3.241 (p-value 0.001) in control and -2.30 (p-value 0.026) in intervention group respectively. Interestingly, the attention domain is improved in the control group with a Z-score of -2.142 (p-value 0.032) rather than in intervention group.

Conclusion: The overall MoCa-Ina score was significantly higher in interventional subjects than control, specifically in the delayed recall domain.

THE CORRELATION OF COGNITIVE FUNCTION TO BRAIN GYM IN THE ELDERLY

2023-09-18T02:19:03+00:00

Background: A decline in cognitive function is often considered normal in the elderly, but the advanced stages of cognitive decline can decrease the ability to perform functional activities. Brain gym is one of the physical activity therapies that is proven to improve cognitive function. The purpose of this study is to know the effect of brain gym on cognitive function.

Objective: This study aims to determine the correlation of cognitive function to brain gym in elderly.

Methods: This is a queasy experimental study in 70 respondent with a pre and post-test group design. The subjects were elderly who were examined with Montreal Cognitive Assessment Indonesian (MoCA-Ina) and Visual Reproduction Test (VRT) on the first day and given brain gym 13 times, which was done 2 times in 1 week and re-examined MoCA-Ina and VRT after the intervention.

Results: The research results show improvement in the MoCA-Ina and VRT pre and post-examinations after being given intervention. In the MoCA-INA examination, the mean score of the pretest was 23.30 and the mean score of the post-test was 24.50, while in the VRT examination, the mean score of the pretest was 10.08, and the post-test mean score was 10.83. However, there was no significant difference between MoCA-Ina or VRT in pre- and post-interventional brain gym (p>0.05).

Conclusion: There is a relationship between cognitive function which is marked by an increase in the results of Moca INA and VRT with brain gym in the elderly at Balearjosari Malang

HYPERTENSION AS DETERMINANT OF COGNITIVE DYSFUNCTION AMONG ELDERLY SUB-POPULATION

2024-02-19T04:16:11+00:00

Background: Cognitive dysfunction is one of the main impacts of hypertension in the elderly population. Early detection and adequate management of early-stage cognitive dysfunction in hypertensive elderly is expected to improve their cognitive status and quality of life.

Objective: This study aimed to determine the association between hypertension and cognitive dysfunction in a sub-population of the elderly in Mataram, Indonesia.

Methods: This cross-sectional study involved elderly sub-population recruited consecutively in three public health centers in Mataram, Indonesia. Data included in this study were age, gender, occupation, educational level, hypertension, diabetes mellitus, and cognitive status. Cognitive status was assessed using the Indonesia version of Montreal Cognitive Assessment instrument. Multiple logistic regression analysis was performed to test whether hypertension was a determinant of cognitive dysfunction in participants taking into account the presence of socio-demographic status and diabetes mellitus as another vascular risk factor.

Results: This study included 88 elderly as eligible participants. The frequency of cognitive dysfunction among participants was 61.4%. Multiple logistic regression analysis revealed that hypertension was the single variable significantly associated with a high frequency of cognitive dysfunction in elderly sub-population (odds ratio = 3.7; 95% confidence intervals = 1.3 – 10.4; p = 0.014).

Conclusion: The frequency of cognitive dysfunction in the elderly sub-population in Mataram was high, amounting to 61.4%. Hypertension was the determinant of this high frequency of cognitive dysfunction in the sub-population studied.

DOES THE COMBINATION OF ROSMARINUS OFFICINALIS AND CENTELLA ASIATICA NANOEMULSIONS AFFECT BDNF EXPRESSION IN THE GESTATIONAL DIABETES MELLITUS MODEL IN ZEBRAFISH LARVAE

2024-02-19T04:22:45+00:00

Background: Pancreatic β-cells compensate for the increased insulin demand due to increasing glucose levels during pregnancy or in gestational diabetes mellitus (GDM). The enzyme that regulates the rate of gluconeogenesis production is PEPCK. Circulatory and metabolic disturbances in the brain caused by hyperglycemia could affect brain-derived neurotrophic factor (BDNF) expression as an agent for neurodevelopment.

Objective: The purpose of this work is to ascertain the impact of combining nanoemulsions of Rosmarinus officinalis and Centella asiatica on the expression of BDNF and PEPCK.

Methods: This study was a true experimental laboratory using zebrafish larvae. The larvae were exposed to 3% glucose and a combination of nanoemulsion extracts. The study sample of zebrafish larvae at 72 hpf (hour post fertilization) was divided into control, glucose, treatment 1, 2, and 3, with the combination of Rosmarinus officinalis and Centella asiatica nanoemulsions at 2.5 μg/ml, 5 μg/ml, and 10 μg/ml, respectively. PEPCK and BDNF expression were measured by the real-time PCR method.

Results: The expression of PEPCK increased significantly in the glucose group (3.05 ± 0.27). The combination of Rosmarinus officinalis and Centella asiatica nanoemulsions significantly decreased PEPCK (p-value 0,001 < 0.05). The BDNF level did not significantly differ (p-value 0.253 >0.05) among groups, but the highest level (1.06 ± 0.60) was gained in the T2 group, which received an embryonic medium (EM), 3% glucose, and the combination of Rosmarinus officinalis and Centella asiatica nanoemulsions at 5μg/ml.

Conclusion: The combination of Rosmarinus officinalis and Centella asiatica nanoemulsions significantly reduces PEPCK expression but does not affect BDNF expression.

NEUROMUSCULAR ELECTRICAL STIMULATION EFFECT ON WRIST SPASTICITY AND FUNCTION IN POST-STROKE PATIENT WITH UPPER EXTREMITY RECOVERY EXERCISE

2024-06-14T05:56:28+00:00

Background : Stroke is still a major health problem in the world and cause disability. Spasticity is one of the disability problems in stroke patients, which is more common in the wrist muscles. Recovery of spasticity is quite difficult and there is no definitive treatment that can speed up the recovery. Electrical stimulation is one of the rehabilitation intervensions that is believed to be able to recover spasticity based on neuroplasticity theory. There has been no consensus for the method of electrical stimulation that can give rise to optimal effects in stroke patients. New studies are still needed to determine effective therapeutic programs.

Objective : The study aims to determine the effectiveness of the use of Wrist Neuromuscular Electrical Stimulation (NMES) against the recovery of spasticity and functional degrees of post-stroke patients who receive upper extremity recovery exercise (URE).

Methods : The study used a randomized controlled trial. The study sample was stroke patients who are treated at dr. Saiful Anwar hospital policlinic. The study involved 30 post-stroke patients who were randomized into NMES combined with URE groups (15 patients) and URE groups (15 patients). Modified Asworth Scale and Fugl-Meyer Assesment of Upper Extremity total were measured before and after interventions. Modified Asworth Scale (MAS) is a scale than use for measure spasticity degree and have very good realibility. Fugl-Meyer Assesment Scaletha (FMA) is a scale for measure fungsionality of extremities which also have good realibility. Neuromuscular Electrical Stimulation (NMES) device is BTL-5000 series.

Results : NMES combined with URE can reduce the degree of spasticity and increase the functional degree of the wrist in post-stroke patients significantly (p<0.05). URE can also significantly reduce the degree of spasticity and increase the functional degree of the wrist (p<0.05). NMES compared to URE futher reduced the degree of spasticity and increased the functional degree of the wrist in post-stroke patients insignificantly (p>0.05).

Conclusion : The mean decrease in the degree of spasticity and increase in functional degree in the NMES group combined with URE measured by MAS scale showing that degree of spasticity with sig 0,101 > alpha (0,05) is not significant, but the mean decrease MAS in the NMES with URE group is bigger than group URE alone. The mean decrease in the degree of spasticity and increase in functional degree in the NMES group combined with URE measured by FMA scale showing that degree of spasticity with sig 0,787 > alpha (0,05) is also not significant, but the mean decrease FMA in the NMES with URE group is bigger than URE alone. This results mean that there is a significant score decrease in spasticity and increase of fungsionality degree before and after URE grop and there is not significant different score using NMES and URE group in MAS and FMA scale.

PROFILE OF DYSPHAGIA IN ACUTE STROKE PATIENTS

2024-01-07T09:33:56+00:00

Background: Stroke has been a leading cause of mortality and disability since 2013, and its incidence continues to rise. Dysphagia is a common complication following stroke, contributing to increased rates of aspiration, pneumonia, and prolonged hospital stays for stroke patients.

Objective: This study aims to investigate the profile and distribution of acute stroke patients experiencing dysphagia who are admitted to RSUD dr. Saiful Anwar in East Java.

Methods: The assessment was conducted on acute stroke patients with compos mentis consciousness in the Stroke Unit from July to September 2023, using the GUSS (Gugging Swallowing Screen) questionnaire. The assessment categories included no dysphagia (20), mild dysphagia (15-19), moderate dysphagia (10-14), and severe dysphagia (0-9).

Results: Data collected during the period from July to September 2023 yielded a total of 35 samples. Based on gender, there were 22 male patients (62.9%) and 13 female patients (37.1%). Regarding age distribution, 15 patients fell into the productive age range (20 to 59 years), while 20 patients were over 60 years old. The majority of cases were ischemic strokes, with 25 patients, and 10 patients had hemorrhagic strokes. Dysphagia assessment using the GUSS method on the 35 samples revealed 2 samples with GUSS scores of 12 and 14 (moderate) and 1 sample with a score of 18 (mild).

Conclusion: The profile and distribution of acute stroke patients experiencing dysphagia were identified, including gender, age, type of stroke, and GUSS scores in acute stroke patients in the stroke unit with Compos Mentis consciousness.

THE RELATIONSHIP BETWEEN RISKS OF OBSTRUCTIVE SLEEP APNEA AND DRY EYE DISEASE

2024-03-01T03:48:32+00:00

Introduction: Dry Eye Disease (DED) may lead to decreased visual function, chronic tissue changes, eyelid, conjunctival, and corneal abnormality. The prevalence of DED in Asia ranges from 21.6%–37.6%. Several studies pointed out the relationship between DED and Obstructive Sleep Apnea (OSA). In patients with OSA, oxidative stress, hypoxia, and ocular surface inflammation increase, leading to a decrease in the functions of meibomian glands, goblet cells, corneal sensitivity, and tear production as a response to the stimulations from the lacrimal glands. The loss of conjunctival goblet cells and meibomian glands are implications of damage to the tear film quality, which results in DED.

Method: This is a population-based cross-sectional study. Data were obtained from the database of Biomarker Smarthealth Research in Mendalanwangi, Sidorahayu, and Cepokomulyo Villages, which are located in Malang Regency, having risks of OSA (based on the STOP-BANG questionnaire), above ≥40 years old, and DED Examination with Tear Break-Up Time (TBUT), MGD (Meibominan Gland Dysfunction), Tear Meniscus (TM) involving a total of 518 respondents. The available data were then processed according to the variables and went through DED examinations. This study employed the purposive sampling method.

Result: In this study, moderate risk of OSA suggests a significant influence on the occurrence of DED with an odds ratio (OR) 1.66 (p<0.05). In addition, moderate risk of OSA predisposes ADDE (Aqueous Deficiency Dry Eye)-type and Mix-type DED with OR 2.85 and 1.23 (p<0.05). High risk of OSA correlates with the occurrence of ADDE-type DED with OR 2.37 (p<0.05). The age group >60 years old shows a correlation with Mix-type DED with OR 2.09 (p<0.05). Women have a higher predisposition to ADDE-type with OR 2.58 (p<0.05).

Conclusion: Moderate risk of OSA influences the occurrence of DED, both ADDE-type and Mix type; whereas high risk of OSA only correlates with ADDE-type. Older age plays a role in the occurrence of Mix-type DED and women have a higher tendency to present with ADDE- type.